A One-center Study of Sixteen Patients with Pregnancy-associated Breast Cancer: Clinicopathological Characteristics and Survival

Year 2018, Volume: 23 Issue: 3, 137 - 142, 26.09.2018

Süleyman Bademler Murat Sarı

https://doi.org/10.21673/anadoluklin.446910

Abstract

Aim: Cancer treatment is of special importance during pregnancy, concerning the health of both mother and baby. Treatment of pregnancy-associated breast cancer (PABC) has become even more important today because women tend to delay pregnancy to later ages and because of women who desire to conceive while under treatment for breast cancer. This retrospective study is aimed at investigating the clinical, radiological and histopathological characteristics and PABC treatment outcomes of patients who had long-term follow-up.

Materials and Methods: Sixteen women diagnosed with PABC were included in this study. We evaluated the clinicopathological characteristics, gestational history, and survival outcomes of the patients who had been treated and followed up for breast cancer during pregnancy and the first postnatal year at Istanbul University Institute of Oncology in 2010–2017.

Results: The median patient age was 32 (21–41) years. The median gestational week of diagnosis in pregnant patients was 26 (11–35) weeks while the mean time elapsed after delivery until diagnosis in postpartum patients was 9.3 (±3.6) months. The median follow-up time was 47.5 (5–99) months. The mean disease-free survival (DFS) and overall survival (OS) were calculated because the median DFS and OS could not be computed. The mean OS and DFS values were 87.8±7.3 and 77.6±8.5 months,respectively.

Discussion and Conclusion: Breast cancer in pregnancy is a special health condition that should be treated and followed up by a multidisciplinary team. Primary surgical intervention should not be delayed. While chemotherapy could be administered safely in the first and second trimesters, radiotherapy and targeted and endocrine treatments should be postponed until after delivery. Reporting and long-term follow-up of cases of pregnancy and cancer concurrence is essential for increasing the relevant knowledge.

Keywords

pregnancy, breast cancer, diagnosis, survival

Gebelikle İlişkili Meme Kanserli 16 Hastaya Dair Tek Merkez Çalışması: Klinikopatolojik Özellikler ve Sağkalım

Abstract

Amaç: Gebelikte kanser tedavisi hem anne hem de bebek sağlığı açısından özel bir öneme sahiptir. Günümüzde
kadınların gebeliği ileri yaşlara ertelemesi ve meme kanseri tedavisi almakta olan kadınların
gebelik isteği nedeniyle GİMK tedavisi giderek önem kazanmaktadır. Bu retrospektif çalışma ile uzun
süreli izlemi olan vakaların klinik, radyolojik ve histopatolojik özelliklerini ve GİMK tedavisi sonuçlarını
incelemek amaçlanmıştır.

Gereç ve Yöntemler: Bu çalışmaya GİMK tanısı almış olan 16 kadın hasta dahil edilmiştir. 2010–2017
döneminde İstanbul Üniversitesi Onkoloji Enstitüsünde gebelik sırasında veya postnatal birinci yılda
meme kanseri tanısıyla tedavi ve takip edilen hastaların klinikopatolojik özellikleri, gestasyonel öyküleri
ve sağkalım sonuçları değerlendirilmiştir.

Bulgular: Medyan hasta yaşı 32 (21–41) yıldı. Gebe hastaların tanı anındaki medyan gebelik haftası
26 (11–35) hafta iken postpartum hastalarda doğumdan sonra meme kanseri tanısına kadar geçen
ortalama süre 9,3 (±3,6) ay idi. Medyan takip süresi 47,5 (5–99) aydı. Medyan genel sağkalım (GS) ve
hastalıksız sağkalım (HS) değerlerine ulaşılamadığı için ortalama GS ve HS hesaplandı. Ortalama GS
ve HS değerleri sırasıyla 87,8±7,3 ve 77,6±8,5 ay idi.

Tartışma ve Sonuç: Gebelikte meme kanseri takip ve tedavisi multidisipliner bir ekip tarafından yapılması
gereken özel bir sağlık sorunudur. Primer cerrahi müdahale geciktirilmemelidir. Kemoterapi
ikinci ve üçüncü trimesterde güvenle uygulanabilirken radyoterapi, hedefe yönelik tedaviler ve endokrin
tedavileri doğum sonrasına ertelenmelidir. Gebelik ve kanser birlikteliği vakalarının bildirilmesi ve uzun
süreli takibi ilgili bilgi birikiminin artması bakımından çok önemlidir

Keywords

gebelik, meme kanseri, tanı, sağkalım

References

• 1. Smith LH, Dalrymple JL, Leiserowitz GS, et al. Obstetrical deliveries associated with maternal malignancy in California, 1992 through 1997. Am J Obstet Gynecol. 2001;184:1504–12.
• 2. Wallack MK, Wolf JA, Jr., Bedwinek J, et al. Gestational carcinoma of the female breast. Curr Probl Cancer. 1983;7:1–58.
• 3. Sukumvanich P. Review of current treatment options for pregnancy-associated breast cancer. Clin Obstet Gynecol. 2011;54:164–72.
• 4. Martin JA, Hamilton BE, Osterman MJK, et al. Births: final data for 2016. Natl Vital Stat Rep. 2018;67:1–55.
• 5. Bonnier P, Romain S, Dilhuydy JM, et al. Influence of pregnancy on the outcome of breast cancer: a case-control study. Int J Cancer. 1997;72:720–7.
• 6. Petrek JA, Dukoff R, Rogatko A. Prognosis of pregnancy-associated breast cancer. Cancer. 1991;67:869–72.
• 7. Basaran D, Turgal M, Beksac K, et al. Pregnancy-associated breast cancer: clinicopathological characteristics of 20 cases with a focus on identifiable causes of diagnostic delay. Breast Care (Basel). 2014;9:355–9.
• 8. Genin AS, De Rycke Y, Stevens D, et al. Association with pregnancy increases the risk of local recurrence but does not impact overall survival in breast cancer: a case-control study of 87 cases. Breast. 2016;30:222–7.
• 9. Langer A, Mohallem M, Stevens D, et al. A single-institution study of 117 pregnancy-associated breast cancers (PABC): presentation, imaging, clinicopathological data and outcome. Diagn Interv Imaging. 2014;95:435–41.
• 10. Asgeirsson KS. Pregnancy-associated breast cancer. Acta Obstet Gynecol Scand. 2011;90:158–66.
• 11. Yang WT, Dryden MJ, Gwyn K, et al. Imaging of breast cancer diagnosed and treated with chemotherapy during pregnancy. Radiology. 2006;239:52–60.
• 12. Amant F, von Minckwitz G, Han SN, et al. Prognosis of women with primary breast cancer diagnosed during pregnancy: results from an international collaborative study. J Clin Oncol. 2013;31:2532–9.
• 13. Beadle BM, Woodward WA, Middleton LP, et al. The impact of pregnancy on breast cancer outcomes in women<or=35 years. Cancer. 2009;115:1174–84.
• 14. Loibl S, von Minckwitz G, Gwyn K, et al. Breast carcinoma during pregnancy. International recommendations from an expert meeting. Cancer. 2006;106:237–46.
• 15. Kizer NT, Powell MA. Surgery in the pregnant patient. Clin Obstet Gynecol. 2011;54:633–41.
• 16. Burstein HJ, Partridge AH, Lesnikoski BA. Treatment of breast cancer during pregnancy. Expert Opin Pharmacother. 2002;3:423–8.
• 17. Lenhard MS, Bauerfeind I, Untch M. Breast cancer and pregnancy: challenges of chemotherapy. Crit Rev Oncol Hematol. 2008;67:196–203.
• 18. Van Calsteren K, Heyns L, De Smet F, et al. Cancer during pregnancy: an analysis of 215 patients emphasizing the obstetrical and the neonatal outcomes. J Clin Oncol. 2010;28:683–9.
• 19. Woo JC, Yu T, Hurd TC. Breast cancer in pregnancy: a literature review. Arch Surg. 2003;138:91–8.
• 20. Ali SA, Gupta S, Sehgal R, et al. Survival outcomes in pregnancy associated breast cancer: a retrospective case control study. Breast J. 2012;18:139–44.